Can a provider bill 150% of the documented cost (invoice) for medical supplies and Durable Medical Equipment (DME) provided to a No-Fault patient?
• Ans: For DMEs supplied to a No-Fault patient prior to October 6, 2004 (the promulgation of the 28th Amendment to Regulation 83), reimbursement was governed by Regulation 83, Part E: Drugs, Medical Equipment and Supplies, which stated that for medical equipment and supplies (e.g. TENS units, soft cervical collars) provided by a physician or medical equipment supplier, the maximum permissible charge is 150% of the documented cost of the equipment to the provider. The documented cost of DME is limited to costs incurred by a provider in a bona fide arms length transaction. Effective October 6, 2004, the maximum permissible charge for the purchase of durable medical equipment, medical/surgical supplies, orthopedic footwear and orthotic and prosthetic appliances is the fee payable for such equipment and supplies under the New York State Medicaid program at the time such equipment and supplies are provided.
Related Questions
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